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Summary of the impact

Over the past 25 years Professor David Peters has developed a
model for successfully
incorporating complementary therapies (CT) for musculoskeletal pain into
the NHS. Research
began in the 1990s. The growth in use of CT (osteopathy and acupuncture)
in musculoskeletal
service innovation in the NHS, is to a large degree a legacy of Peters
work. His integrative model
was adopted in GP practices nationally including Glastonbury Health
Centre, Blackthorn Centre in
Maidstone, Lewisham Hospital Trust, and the Liverpool Centre for Health.
NICE subsequently
included acupuncture and osteopathy in its guidelines for managing
musculoskeletal pain.

Underpinning research

Professor Peters first published papers on the feasibility of
collaborative working with
complementary practitioners in NHS general practice in the early 90s
(Reason, Peters et al. 1991),
while at the Centre of Community Care and Primary Health, which was
affiliated with the University
of Westminster. Peters then came to the University of Westminster in 1992
as a senior lecturer,
where he further developed his musculoskeletal work/integrative model
around acupuncture and
osteopathy (Peters & Davies 1994). The integrative model he pioneered
from Westminster, starting
at the Marylebone Health Centre (MHC) in the 1990s, had a national
influence. Other groups
subsequently established versions of his integrative model in their own
areas (e.g. Healthworks
Newcastle, Cullompton Integrated Medical Centre) (Peters et al. 2003). The
model was
considered in the inquiry undertaken by the House of Lords Select
Committee in 2000, which
influenced the recommendations of its report
(http://www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12326.htm).

1991-1994 Developing a model for the Extended Primary Care team
incorporating
complementary practitioners. Exploring the feasibility of using
complementary therapies in
NHS primary care. Produced papers on the model itself and a feasibility
study on NHS
osteopathy.

1995-2002 Consolidating the model and developing audit and
outcomes evaluation
systems. This phase of work produced a workbook for emulating the model.
(Involving
qualitative and action research, consensus building, pragmatic
outcomes collection,
development of databases and audit systems).

2002-5 The increasing popularity of these approaches in the NHS
made it necessary to
develop clinical governance guidelines (Involving action and
qualitative research and
Delphi exercises).

2006-12 New services of osteopathy and acupuncture for pain
were established by the
University of Westminster in the NHS, e.g. Victoria Medical Centre,
Kensington & Chelsea
PCT (and evaluated by Professor Damien Ridge, Dr Marie Polley
and Dr Anna
Cheshire, at the University of Westminster). For example,
integration for musculoskeletal
pain in an NHS GP surgery: In terms of effectiveness, comparisons
between pre and post-treatment
revealed a statistically significant improvement in MSK pain (p <
0.0001) and
quality of life (p < 0.0001), and a statistically significant
reduction in medication use (p <
0.0001). Qualitative analysis found that patients reported improvements
in their MSK pain,
mobility, other physical health conditions, well-being and
self-management of their MSK
problem. (see: http://www.biomedcentral.com/1471-2296/12/49).

Reason P, Peters D et al. A model for collaboration between conventional
and complementary pract
Journal of the Royal Society of Medicine, April 1991

Peters D, Davies P. A study of one year's referrals to an osteopathic
clinic in general practice.
Jour Roy Coll GP. Jan 1994

Wilkinson J, Donaldson J, Peters D. Clinical Governance for Complementary
Therapies in Primary
Care. Final Report to the Department of Health and the Kings Fund.
University of Westminster
October 2004.

Details of the impact

The integration of non-conventional treatment methods such as osteopathy
and acupuncture into
mainstream public sector primary care has been a gradual process. A small
number of early
adopters piloted NHS services in the 1980s. Peters, who was
Director of the Complementary
Therapies team at the Marylebone Health Centre (MHC) played a leading part
after Dr Patrick
Pietroni gained the necessary funding (£750,000) to inaugurate the St
Mary's Medical
School/Waites' Project (extended primary care team project) in1988 and
appointed Peters as
Senior Research Fellow. Peters co-authored a paper on the feasibility of
collaborative working in
an extended primary care team that included complementary practitioners in
NHS general practice
in 1991 (Reason P, Peters D et al 1991 ibid). Peters and Davies published
a preliminary
description of the MHC musculoskeletal acupuncture and osteopathy service
in 1994 (Peters D,
Davies P 1994 ibid), and in the same year provided a chapter on the
benefits and challenges of
doctors and complementary practitioners sharing responsibility for patient
care.

MHC's inter-professional learning and multidisciplinary primary care team
model became the focus
of academic study with the establishing of the Centre for Community Care
and Primary Health at the
University of Westminster. The collaborative model had national influence.
Other groups
subsequently established versions of the integrative model in their own
areas (in particular Liverpool
Centre for Health, Lewisham Hospital NHS Trust Complementary Therapy
Centre, Glastonbury
Health Centre, Healthworks Newcastle, Cullompton Integrated Medical
Centre). Then, as GP fund-holding
was succeeded by PCT multi-funds in the mid-90s, a community-based version
of the MHC
model made acupuncture and osteopathy available PCT-wide via the
Westminster PCT
Complementary Therapies Service.

This in turn acted as a model for PCTs nationally: a national survey
conducted in 2002-3 (to which
66% of PCTs responded) showed that 30-63.2% of the responding PCTs
declared they were
providing community access to complementary therapy services (Wilkinson J,
Donaldson J, Peters
D. 2004 ibid). The House of Lords Science and Technology subcommittee on
Complementary
Therapies took on the integrative model as one of its key case studies.

Peters work was written up in a workbook published in 2002 (Peters et al.
2002) which was well-reviewed
(e.g. by Lewith, Freshwater, Dijkstra), and attracted praise even from
those who have
reservations about integrating complementary therapies into mainstream
healthcare (Ernst 2002).
The demonstrable and growing presence and popularity of osteopathy and
acupuncture in the NHS
led to the inclusion of osteopathy in the 2001 RCGP guidelines on low back
pain. Subsequently,
the 2009 NICE guidelines on early intervention in acute low back pain
included osteopathy and
acupuncture (see http://www.nice.org.uk/CG88).

Subsequently, we set up and tested the model in various NHS settings. It
was evaluated and shown
to be effective through research at the Victoria Medical Centre by the
University of Westminster
(http://www.biomedcentral.com/1471-2296/12/49).
Out of this work, another service for
musculoskeletal pain was established for Kensington & Chelsea PCT in
2010-11. The Kensington &
Chelsea Beating Back Pain Service (BBPS) was a pilot service for patients
with persistent low back
pain. An evaluation, conducted by Ridge, Cheshire and Polley
found 38% of patients experienced
a clinically significant improvement in their pain at 3-month follow-up
(in press,
http://www.biomedcentral.com/bmccomplementalternmed/).
As a consequence of having led these
developments in NHS care, Peters was invited to participate in the ARC
symposium on research
priorities on the role of complementary therapies in MSK disease in 2009,
and in 2012 he gave
evidence to the House of Commons Health Select Committee on workforce
planning in relation to
CM in the NHS (http://www.parliament.uk/business/committees/committees-a-z/commons-
select/health-committee/news/12-01-19-etwp-ev3/). The team at
Westminster are now involved in
commercializing this work in the new NHS commissioning environment, for
example, developing an
online self-care library (http://selfcare-library.info/)
which presents the evidence-base for the use of
CT and self-management options. Additionally, the recent establishment of
the Westminster Centre
for Resilience at the University will research the use of
non-pharmacological interventions in long-term
chronic conditions.